Aspirin a Day? Know the Risks, Benefits

Should you, or should you not, take a daily aspirin to prevent heart attack or stroke? It’s a matter of weighing the benefits against the risks, with the help of your doctor or health care provider, advises Eddie Davenport, MD, of Miami Valley Cardiologists.

The evidence is clear that a daily dose of aspirin reduces risk for a second heart attack or clot-related stroke. But if you have a healthier heart, the risks of daily aspirin — such as increased bleeding — may exceed the benefits.

“If you have a 10 percent or greater risk of coronary artery disease or stroke, you should be on aspirin,” Dr. Davenport says.

Dr. Davenport says, “If you’ve had a heart attack, if you’ve had a stroke or if you’ve had a stent placed (in an artery) or bypass surgery, aspirin will definitely decrease your risk of dying 20, 30 percent over a 10-year period.”

What role does aspirin play in preventative health?

Aspirin has been found recently to do a lot to prevent disease. One of the ways it does this is inhibiting something called cyclooxygenase which is a chemical that your body releases with inflammation. And in turn, that enzyme will decrease something called prostaglandin. And prostaglandin does a lot of things. One of the things it does is decreases or increases inflammation. So if you bump your elbow or something, you get increased inflammation. Prostaglandin will make that all worse. It tells your brain, “Hey, I’ve hurt myself,” so you get the pain and you also get swelling and inflammation. And let’s say you’re bleeding, it will also tell your body to help form blood clots. So it acts on platelets to form blood clots. What aspirin does is it inhibits that cyclooxygenase which then inhibits the prostaglandin. So it decreases pain. It decreases inflammation.

One of the things – side effects we used to think is it increases risk of bleeding because it makes those platelets not as sticky. Well, we found out that this is actually – sticky platelet is bad for heart disease. If you have inflammation in an artery, you have a blockage in an artery, you can actually have what we call rapture of that plaque and an artery allow to sticky platelets will clog up that artery. And if you clog up an artery going to their head, it’s called a stroke. You clog up an artery going to the heart, it’s going to cause a heart attack.

So aspirin will prevent those. And so we know for sure, without a doubt that if you’ve had a heart attack, if you’ve had a stroke or if you’ve had a stent placed or bypass surgery, aspirin definitely will decrease your risk of dying 20 to 30% over a 10-year period. So it’s very good for that. The risk with that is it does increase risk of bleeding. So there has been – you know, preventive health-wise, you don’t want to put everybody on it to prevent something unless we know they have a disease process.

And the latest preventive health measures we found out now, is they took a bunch of folks they put on aspirin for many, many years, at least 5 – over 10 years on aspirin to prevent heart disease and what they saw is a decrease in colorectal cancer, decrease in breast cancer, decrease in prostate cancer, and they even think it may decrease dementia and Alzheimer’s disease.

So it’s doing a lot besides inhibiting platelets. Now, it’s probably as anti-inflammatory fix are working in other ways. So most recently, what we’re worried about though is bleeding, you know? So if you don’t have any risk factors for any of those things and you just take aspirin for no good reason, you have a risk of bleeding. You bleed in your brain or you can bleed in your gut. So that risk benefit ratio is what we have to think about when were talking about preventive health and how aspirin – its role in that.

Aspirin Not for Everyone

The American Heart Association also recommends a daily aspirin if you are at high risk of a first heart attack or stroke, as determined by your doctor or health care provider.

“If you have a 10 percent or greater risk of coronary artery disease or stroke, you should be on aspirin,” Dr. Davenport says. To determine risk, doctors use a variety of factors such as age, gender and assessments of cholesterol, blood pressure and other health indicators.

Aspirin thins blood, lowering the risk of clot formation that can trigger heart attack and stroke. For those with lower heart disease and stroke risk, this blood thinning quality raises the potential risks of aspirin above its benefits.

In this case, aspirin can bring on unwanted side effects, such as bleeding into the brain or gastrointestinal tract and bleeding from minor injuries that normally would only bruise.
Dr. Davenport discusses the benefits and risks of using aspirin as part of a preventive health routine.

What are the benefits and risks of taking aspirin as part of a preventative health routine?

So when do you use aspirin? If you’re a certain cardiovascular risk. So my response would be, don’t be at that certain cardiovascular risk. Have your blood pressure controlled. Have your good diet, exercise, do all the things that you don’t need the aspirin because you don’t have that risk. I think that’s the right answer. And we’re learning this more and more.

Now, the other question is should we do it preventively? Should we give it to folks to prevent heart disease before it happens? Something we call primary prevention. And in this primary prevention model, there’s a lot of controversy because of the increased risk of bleeding. So we used to say, if you had greater than a 10% risk, so if you have a 10% or greater risk of having coronary artery disease or stroke, then you should be on it.

And that’s what just came out by the task force recently that said, “Hey, you have greater than 10% risk.” Well how do you know, if you have 10% risk? All kind of calculators online. One of them is the Framingham Risk Score. You probably heard about this. It’s been around many, many years. There’s, Reynolds risk score. There’s a Europe risk score. There’s the new ACC/AHA risk score. And what these risk scores are you put in your age, you put in your – what sex or gender you are and then you put in your cholesterol numbers, your blood pressure numbers and it says here’s your risk over 10 years of having an MI or heart attack or stroke. And if that risk is over 20%, you’re really high risk and you should be on an aspirin.

The controversy is this 10 to 20% risks. What if you’re in that intermediate risk, should you? And the latest guidelines are, yeah, you should and you should be on it if you don’t have a risk of bleeding, you don’t have these risks that we worry about GI. If you’ve ever had a GI bleed or if you’ve ever had a bleed in your head, you shouldn’t – you probably shouldn’t be on it. So you weigh those risks and benefits.

Talk with Your Doctor First

To know whether regular aspirin use is appropriate for you — that the benefits outweigh the risks — talk with your doctor or health care provider. Ask:

What are your chances of having a heart attack or stroke in the next 10 years?

Would aspirin benefit you?

What side effects could you experience from taking aspirin?

Will aspirin interfere with or negatively interact with other medications you take?

Should you stop taking aspirin before surgery or dental work?

Make sure your doctor is fully aware of your medical history — in particular, ulcers or bleeding problems — and all medications and supplements you take. Your doctor can advise you of potentially harmful interactions of aspirin with blood thinners and other prescription medications, supplements and over-the-counter medications.

Dr. Davenport discusses when to ask your medical provider if aspirin would be beneficial.

When should a person ask their physician if aspirin would be beneficial to them?

Everybody should have a regular health maintenance. And that’s why I’m glad were talking about this as a preventive measure because it is very important. I think it’s indicated in these certain populations. And like you said, if you go online, you’re going to find a bunch of people saying you should or shouldn’t be on it. You could find those risk calculators. But every doctor I know has the app. You know, we will tell you what your risk is and should you be not – and should you be on aspirin or not. And, so I would definitely say talk to your doctor and they’ll inform you like we’re doing here and if you should be on it and weigh those risks and benefits. That’s would – that’s all medicine these days, the risk and benefit ratio.